Evidence map›Paper›PMID 24705780›Full record

Observational studyWorld journal of surgery2014

Assessing surgical quality: comparison of general and procedure-specific morbidity estimation models for the risk adjustment of pancreaticoduodenectomy outcomes.

C Ansorge, P Lindström, L Strömmer, J Blomberg, L Lundell, A Andrén-Sandberg, M Del Chiaro, R Segersvärd

Abstract readComparative StudyObservational Study
PubMed Publisher
In one paragraph

Observational study in World journal of surgery, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

C AnsorgeDivision of Surgery, K53, Department of Clinical Science, Intervention and Technology (CLINTEC), Department of Surgical Gastroenterology, Karolinska Institutet at Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden, christoph.ansorge@ki.se.
P Lindström
L Strömmer
J Blomberg
L Lundell
A Andrén-Sandberg
M Del Chiaro
R Segersvärd

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionThe use of outcomes to evaluate surgical quality implies the need for detailed risk adjustment. The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) is a generally applicable risk adjustment model suitable for pancreatic surgery. A pancreaticoduodenectomy (PD)-specific intraoperative pancreatic risk assessment (IPRA) estimates the risk of postoperative pancreatic fistula (POPF) and associated morbidity based on factors that are not incorporated into POSSUM.

objectiveThe aim of the study was to compare the risk estimations of POSSUM and IPRA in patients undergoing PD.

methodsAn observational single-center cohort study was conducted including 195 patients undergoing PD in 2008-2010. POSSUM and IPRA data were recorded prospectively. Incidence and severity of postoperative morbidity was recorded according to established definitions. The cohort was grouped by POSSUM and IPRA risk groups. The estimated and observed outcomes and morbidity profiles of POSSUM and IPRA were scrutinized.

resultsPOSSUM-estimated risk (62 %) corresponded with observed total morbidity (65 %). Severe morbidity was 17 % and in-hospital-mortality 3.1 %. Individual and grouped POSSUM risk estimates did not reveal associations with incidence (p = 0.637) or severity (p = 0.321) of total morbidity or POPF. The IPRA model identified patients with high POPF risk (p < 0.001), but was even associated with incidence (p < 0.001) and severity (p < 0.001) of total morbidity.

conclusionThe risk factors defined by a PD-specific model were significantly stronger predictive indicators for the incidence and severity of postoperative morbidity than the factors incorporated in POSSUM. If available, reliable procedure-specific risk factors should be utilized in the risk adjustment of surgical outcomes. For pancreatic surgery, generally applicable tools such as POSSUM still have to prove their relevance.

Indexed as

Quality of Health CareSeverity of Illness IndexAdultAgedAged, 80 and overFemaleHospital MortalityHumansIncidenceIntraoperative CareMaleMiddle AgedPancreatic FistulaPancreaticoduodenectomyProspective StudiesRisk Adjustment

Identifiers

PMID24705780

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.